Exploring the Power of Peer-related Social Factors in Mediating the Effects of Pain on Loneliness and Stress in Adolescents

Background: Chronic pain in adolescents is associated with loneliness and increases in stress, which in turn elevate the risk of worse pain-related outcomes. Positive peer-related social factors mediate the relationship between stress and loneliness amongst those without pain, but it is not known if this holds in the presence of pain characteristics. It is also unknown if peer-related social factors (e.g., social support) mediate the relationship between pain characteristics and loneliness. Methods: A cross-sectional survey using validated measures was completed by 128 adolescents with chronic pain. Mediation with moderation analysis using Hayes Process Macro was conducted to explore if peer-related social factors mediated the relationship between pain intensity and pain-related interference on loneliness and stress as well as stress on loneliness. Demographic variables were assessed as moderators. Results: One's perceived social competence and social support from friends mediated the relationship between pain characteristics and loneliness, pain characteristics and stress, and stress and loneliness for males and females. The number of friends did not mediate these relationships. Socioeconomic status moderated the relationship between pain characteristics and stress, with those in higher income families experiencing significant increases in stress as pain characteristics increased. Conclusion: Strengthening peer-related social factors is a promising avenue for chronic pain management for adolescents as these factors explain why some adolescents with chronic pain experience less loneliness. Examining the effectiveness of evidenced-based interventions found to decrease loneliness in adolescents without pain is warranted in this population. Significance Statement: Adolescents with chronic pain are at risk for increases in loneliness and stress, both of which are associated with worse pain-related outcomes. Using validated measures, findings indicate that peer-related social factors meditated the effect of pain intensity and pain-related interference on loneliness and stress. Peer-related social factors were also significant in mediating the relationship between stress and loneliness. Peer-related social factors contribute to resiliency amongst adolescents with chronic pain and offer a promising avenue to improve pain-related outcomes.